The MPL Association’s Inside Medical Liability Online is pleased to share an interview with Robert E. White, Jr. With 58 years of experience in the MPL insurance industry, White is currently President of TDC Group and is responsible for the operation of TDC Group’s three strategic business units: The Doctors Company, Healthcare Risk Advisors, and TDC Specialty Underwriters.
White is the recipient of the 2026 Award of Excellence in Honor of Peter Sweetland. This award recognizes his outstanding contributions and longtime dedication to the MPL insurance community, healthcare professionals, and the MPL Association.
Inside Medical Liability Online: What is the biggest transformational shift in the MPL landscape that you’ve witnessed during your career, from the days of insuring individual physicians to today’s larger groups and systems?
Bob White: Most people would say predictive modeling and data analytics, but in my view, these are still works in progress whose full benefits have yet to be realized. The biggest transformational shift, in my view, is how MPL moved from a small line written largely for individual physicians into a specialized, mission-driven discipline that now supports larger and more complex health systems.
That evolution accelerated in the early 1970s as claims frequency and severity rapidly escalated, premiums climbed sharply, and much of the conventional market pulled back. In that environment, physician-owned, physician-focused carriers emerged to fill the void created by their exodus. These new companies then created the Physicians Insurers Association of America (PIAA), which ultimately evolved into today’s MPL Association, bringing structure and shared purpose to the market.
Peter Sweetland was one of the foundational leaders in that effort, and his early vision helped shape the industry’s long-term commitment to protecting healthcare professionals and supporting safer care. I was lucky to have worked with Pete when the Medical Inter-Insurance Exchange of New Jersey (MIIX) was formed, and I was exposed to his vision for these newly created companies. That experience helped shape my commitment to this line of business and to the MPL Association.
When I started in the 1960s, malpractice coverage didn’t command much attention. Many physicians paid only a few hundred dollars a year, and insurers often treated it as routine. That changed quickly in the early 1970s. Premiums climbed sharply; some physicians saw cumulative rate increases of 300 to 400% from roughly 1971 to 1974, and by 1975 much of the conventional market had pulled back, raising doubts about whether capacity and pricing could keep pace with losses.
Physician-owned carriers, supported by collaboration through PIAA and its successors, helped the industry respond in a more durable way. And as medicine consolidated, the center of gravity shifted again. MPL increasingly had to underwrite and serve larger groups and systems, with deeper analytics, more sophisticated risk management, and a long-term defense posture.
Even as structures and economics changed, physicians choose this field to help people and practice good medicine. The partnership between the MPL Association and its member companies has enabled us to elevate the dialogue and advocate effectively on behalf of physicians, allowing them to focus on patient care. The unique affinity of interest we share with our insureds enables us to do this.
IML Online: Why was that evolution, from individual physicians to larger groups and systems, supported by physician-owned carriers, so transformational for the industry?
White: It was transformational because it changed both the staying power of the market and the sophistication of what MPL providers do. When malpractice was treated as a small, peripheral coverage, it was often priced thinly and not built for volatility, so when conditions deteriorated, traditional capacity quickly disappeared.
Physician-owned companies provided a durable alternative, and PIAA (now the MPL Association) helped bring structure and shared purpose to a fragmented space. That physician-focused model created a long-term alignment between the insurer and the clinicians it serves, supporting stability through difficult cycles and sustained investment in patient safety, physician advocacy, and protecting the professional reputations of insureds in court.
Just as importantly, it positioned MPL to keep pace as medicine shifted from independent physicians to larger groups and health systems. Underwriting a complex organization requires a different toolkit, including credible experience rating, deeper data, and coordinated risk management across teams, sites, and settings. Those capabilities are now central to the line.
You can see that shift in how accounts are priced. About 25 years ago, we quoted a large academic physician group and used actuarial experience rating for the first time. At the time, applying that kind of actuarial approach in healthcare was unheard of and our competitor, who priced the account using the traditional method, publicly complained that we drastically underpriced the exposure. That account is still with us and remains profitable to this day.
IML Online: How has the risk profile of physicians and hospitals fundamentally changed in the last half century?
White: The clinical mission hasn’t changed. Patients still deserve competent, compassionate care. But the context in which care is delivered is fundamentally different from what it was 50 years ago. Practice structures are larger and more complex, more physicians are employed by health systems, and care is delivered across teams, sites, and settings with more handoffs, more documentation expectations, and more entities involved in a single episode of care. That complexity expands the footprint of risk because an adverse outcome can involve multiple clinicians, organizations, and coverage layers.
At the same time, expectations have shifted. Medicine is more advanced, which is wonderful, but that can raise the standard that patients assume is achievable, even when cases are high acuity, outcomes are uncertain, or underlying conditions are complex. The risk profile is shaped not only by clinical exposure but also by how outcomes are interpreted and valued in the legal system. When large verdicts become the benchmark, they influence settlement demands, reserving, and the willingness of plaintiffs to take cases to trial.
For MPL carriers, that means staying relentlessly focused on the fundamentals that reduce risk and improve outcomes over time, including strong patient safety and risk management support, early identification of severity drivers, and a high-quality defense strategy that matches the realities of modern litigation. For clinicians and hospitals, it reinforces that good medicine includes good communication, reliable systems, and team-based practices that reduce avoidable harm. Those elements improve care, and they often shape how a case unfolds if something goes wrong.
IML Online: How should MPL carriers evaluate the sustained impact of social inflation, including anchoring and litigation financing, on large-verdict frequency and severity, and what does that mean for their long-term financial exposure?
White: Carriers should evaluate social inflation the way you evaluate any durable loss-cost driver. Assume it is persistent, quantify it with credible data, and build it into long-range planning rather than treating it as a temporary spike. Anchoring, litigation financing, and reptile tactics are not passing fads.
They represent an evolved plaintiffs’ playbook that can elevate both the frequency of nuclear verdicts and the severity of outcomes when they occur. Because MPL is a long-tail line, the effects compound. What happens in the courtroom today influences settlement expectations and reserve adequacy for years.
For context, we are seeing roughly 60 nuclear verdicts in a year, meaning verdicts of $10 million or more. In 2025, there were 60 nuclear verdicts, and we have averaged about 60 annually over the last four years. Even though those outcomes represent a small share of total cases, they set the benchmark for settlement demands and can influence reserving and pricing across the entire book.
Financially, that means higher tail risk over longer time horizons, greater uncertainty in ultimate loss costs, more pressure on reserves, and increased importance of disciplined underwriting and reinsurance strategy. It also reinforces that the best defense is preparation. That includes retaining and training top defense counsel, using analytics to identify and manage severity drivers early, and making clear-eyed decisions about when to try cases and when to resolve them. In other words, you do not spreadsheet your way out of social inflation. You respond with a combination of data, expertise, and courtroom readiness.
If severity and frequency rise together, the stress eventually shows up in rates. Over time, that can create real affordability and capacity pressure for physicians and hospitals, especially in higher-risk specialties and underserved regions. When coverage becomes harder to obtain or significantly more expensive, it is not just a carrier problem or a clinician problem. It becomes an access-to-care problem for patients.
Our job as an industry is to stay ahead of that curve by strengthening defense and risk management, advocating for balanced reforms, and maintaining the financial strength necessary to stand with healthcare professionals for the long term.
IML Online: What’s changing, and what is staying the same, as technology equips insurers and underwriters with data and tools?
White: What’s changing is our ability to turn information into insight faster. Stronger data, analytics, and workflows can support more consistent underwriting decisions, improve service, and help us spot emerging risk trends earlier. Technology can reduce friction for agents and members, streamline submissions, and create a clearer picture of risk across complex organizations, especially as practice structures evolve and exposures shift across teams and sites.
What stays the same is the need for experienced judgment and a mission-first mindset. Data and tools can inform decisions, but they do not replace the fundamentals: understanding how medicine is practiced, partnering with clinicians on patient safety, and standing with them when they are sued. In a world shaped by social inflation, those human elements matter even more, including how we communicate, how we support members through stressful events, and how we prepare and defend cases thoughtfully. The best technology supports that work by giving people more time to apply expertise where it counts.
When used effectively, especially in underwriting and operations, technology can reduce friction in routine tasks and allow experienced teams to focus on complex cases where judgment is most critical. The physician-owned model reinforces this approach by naturally aligning with the clinicians we serve.
The goal should be to enable better decisions and stronger support, not simply faster processing. And we need to be clear about the boundary: technology cannot replace the physician. As AI and other tools become more embedded in care delivery, the risk is not the technology itself, it is how it is deployed. If it is applied without care, technology can separate patients from the physicians responsible for their care. That introduces gaps in communication, weakens continuity, and dilutes accountability at the moments it matters most.
This is where physician-owned insurers can make a meaningful difference. Grounded in the realities of clinical practice, they understand that the patient-physician relationship is not a variable to optimize around. It is the foundation of quality care and, increasingly, the foundation of defensibility. The best use of technology is to strengthen that relationship by improving insight, supporting better decisions, and helping physicians stay connected to the patients who depend on them.
IML Online: Looking ahead, what policies or legal reforms would most meaningfully stabilize the MPL market?
White: Reforms that bring predictability and balance back to the system would be among the most meaningful stabilizers because volatility in awards ultimately translates into volatility in coverage affordability. In my view, addressing runaway noneconomic damages is central, since that portion of awards is often the most susceptible to anchoring and emotional amplification. Thoughtful caps, designed appropriately and maintained realistically over time, help preserve fairness and predictability without removing accountability.
It is also worth recognizing that many reforms on the books were set decades ago and have eroded in practical effect because they were never adjusted for inflation, or because later legal changes weakened them. Modernizing those frameworks is part of the solution. I also believe we need much greater transparency around third-party litigation funding so decision makers and the public understand who is financing cases and how that can influence settlement behavior and trial strategy.
At the end of the day, the goal is market stability in service of healthcare stability so physicians can focus on patients, not on practicing defensive medicine in response to a system that has drifted away from its intended purpose. Balanced reforms, combined with strong defense, patient safety efforts, and industry collaboration, are how we keep coverage accessible and affordable and protect patients’ access to care.